@article {Ederjrheum.220312, author = {Lihi Eder and Ashish J. Mathew and Philippe Carron and Heidi Bertheussen and Juan D. Ca{\~n}ete and May Azem and Andrea Delle Sedie and Carlo Salvarani and Roberto Ranza and Ashley Elliott and Anthony Turkiewicz and Ricardo Acayaba de Toledo and Hulya Bukulmez and Maria S. Stoenoiu and Arthur M. Mandelin II and Michaela Koehm and Chris Lindsay and Evan Siegel and Philip J. Mease}, title = {Management of Enthesitis in Patients With Psoriatic Arthritis: An Updated Literature Review Informing the 2021 GRAPPA Treatment Recommendations}, elocation-id = {jrheum.220312}, year = {2022}, doi = {10.3899/jrheum.220312}, publisher = {The Journal of Rheumatology}, abstract = {Objective Enthesitis is a key pathological and clinical feature of psoriatic arthritis (PsA) in children and adults. Enthesitis is typically assessed clinically using several validated enthesitis scoring systems that have been used in clinical trials. Enthesitis treatment response has been reported as change in the total enthesitis score or the proportion of patients who achieved complete resolution. The majority of trials in PsA did not require patients to have enthesitis at study entry since enthesitis was evaluated only as a secondary outcome. Despite the inherent limitations of the clinical assessment of enthesitis, imaging of the entheses using ultrasound or magnetic resonance imaging has rarely been used in clinical trials to assess response to treatment of enthesitis. This systematic review summarizes existing evidence regarding pharmaceutical and nonpharmaceutical interventions for enthesitis in patients with PsA to facilitate an evidence-based update of the Group for Research and Assessment in Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations for PsA. Methods We performed a systematic literature review to identify 41 randomized clinical trials that reported enthesitis treatment response in patients with PsA. For each intervention, the response effect size was summarized and the quality of evidence was graded. Recommendations were then formulated for the various pharmacological and nonpharmacological therapies. Results We included 41 randomized clinical trials in our review and graded each intervention. Conclusion Several classes of systemic conventional and advanced therapies and local measures were recommended for active enthesitis in patients with PsA.}, issn = {0315-162X}, URL = {https://www.jrheum.org/content/early/2022/10/26/jrheum.220312}, eprint = {https://www.jrheum.org/content/early/2022/10/26/jrheum.220312.full.pdf}, journal = {The Journal of Rheumatology} }